Greenslopes Private Hospital, QLD, Australia; Cardiology Department, Concord Hospital, Hospital Road, Concord 2139, NSW, Australia.
Cardiology Department, Concord Hospital, The University of Sydney, Hospital Road, Concord 2139, NSW, Australia.
Int J Cardiol. 2019 Mar 1;278:162-166. doi: 10.1016/j.ijcard.2018.12.063. Epub 2018 Dec 27.
Congestive heart failure (CHF) is a risk factor for pulmonary embolism (PE). PE is also an independent predictor of death or re-hospitalization among CHF patients. We assessed the incidence of CHF admission following acute PE using population-linkage analysis.
Patients were identified from a comprehensive single-center PE database and CHF admissions or death after their PE were tracked from the statewide Admitted Patient Data Collection and Death registries respectively. Patients were divided into two groups: Group-1 were patients without a history of CHF and left ventricular ejection fraction (LVEF) ≥50%; Group-2 were patients with a history of CHF and/or LVEF <50%. Cox regression was used to identify independent predictors for post-PE CHF admission or death.
The study cohort comprised 515 patients (Group-1: n = 338 [65.6%]; Group-2: n = 177 [34.4%]). The incidence of first CHF hospitalization after discharge for acute PE over a mean (±SD) follow-up period of 4.7 ± 3.7 years for the total cohort was 71 (13.8%), with the rate significantly higher in Group-2 than Group-1 (Group-2: [n = 58] 9.11 per-100-patient-years vs Group-1: [n = 13] 0.73 per-100-patient-years). Independent predictors for CHF admission or death after acute PE were older age, male gender, history of CHF or malignancy, low day-1 serum hemoglobin, on diuretics during index PE admission, LVEF <50%, and elevated right ventricular-atrial pressure gradient on echocardiography.
We report a high incidence of CHF requiring hospital admission after acute PE. Surveillance for new-onset heart failure and close monitoring for heart failure decompensation following acute PE particularly in at-risk groups may be warranted.
充血性心力衰竭（CHF）是肺栓塞（PE）的危险因素。PE 也是 CHF 患者死亡或再住院的独立预测因素。我们使用人群关联分析评估急性 PE 后 CHF 入院的发生率。
从综合单中心 PE 数据库中确定患者，并分别从全州住院患者数据采集和死亡登记处追踪 PE 后的 CHF 入院或死亡。患者分为两组：组 1 为无 CHF 病史和左心室射血分数（LVEF）≥50%的患者；组 2 为有 CHF 病史和/或 LVEF<50%的患者。Cox 回归用于确定 PE 后 CHF 入院或死亡的独立预测因素。
研究队列包括 515 名患者（组 1：n=338[65.6%]；组 2：n=177[34.4%]）。在总队列的平均（±SD）随访期 4.7±3.7 年内，首次因急性 PE 出院后发生 CHF 住院的发生率为 71 例（13.8%），组 2 的发生率明显高于组 1（组 2：[n=58]每 100 名患者年 9.11 例，组 1：[n=13]每 100 名患者年 0.73 例）。急性 PE 后发生 CHF 入院或死亡的独立预测因素为年龄较大、男性、CHF 或恶性肿瘤史、入院时第 1 天血清血红蛋白较低、指数 PE 入院期间使用利尿剂、LVEF<50%和超声心动图上右心室-心房压力梯度升高。
我们报告了急性 PE 后需要住院治疗的 CHF 发生率较高。可能需要对高危人群的新发心力衰竭进行监测，并密切监测急性 PE 后心力衰竭失代偿的情况。
